About This Clinic

Bolinas is a town in Marin County at the southern tip of the Point Reyes National Seashore. It is 30 miles north of San Francisco and is surrounded by the ocean and well-preserved parklands. The need for a new health center became apparent when the original downtown Bolinas location was non-ADA compliant. At the same time, the Bolinas fire department was planning to build a new facility and both entities thought it would be a great idea to collaborate. The site, about a mile north of downtown Bolinas, included two community parks and great views. The wind flow, sun path, storm directions, noise, and privacy issues were all factors studied to achieve the ideal site placement for both the health center and the fire department.

Planning for the two facilities included the participation of key stakeholders: residents of the community and patients of the Coastal Health Alliance (Stinson Beach, Point Reyes, and Bolinas). Weekly "ground committee" meetings were established for the two organizations to discuss exterior finishes, paint colors, and joint-purchasing. Because the two buildings were going to be the largest in town, the exterior colors and materials were drawn from the surroundings to minimize the impact of the site and to blend in as much as possible with the surroundings. The Bolinas Health Center staff attended seminars and other events sponsored by the National Association of Community Health Centers, Capital Link, and California Primary Care Association to help in determining the scope of the project, financing options, assessing the needs of the population, and square footage of the building. While planning the design of the health center, staff flow, including the number of steps taken between supply rooms, exam rooms, and staff work areas, was also studied.

Nine years in the making and opening in September 2007, the 2,635 sq ft health center's program components include three general treatment rooms (one dedicated to pediatrics) one trauma room for minor procedures such as stitches, and one mental health room, which also functions as a consult room. Staff areas include a lab, a shared physician office, kitchen and break spaces as well as a shared nurse work station, medical records and storage room, and a private office to provide primary and preventative medical care.

Built Environment Features

Being situated on a site with two community parks and being surrounded by rolling hills, protected parkland, and adjacent to the Pacific Ocean, nature is a major presence at the Bolinas Health Center. Upon entry to the building, an extended waiting area is covered by a trellis with wooden benches for seating. Children can play in the park prior to their appointment; other patients and visitors can just enjoy being outside. Inside the building, the open plan allows ample daylight within the space. The warmth of the interior is reinforced by the bright color palette (greens and yellows), wood finishes, plants, fresh flowers, and local artist's artwork. Within the interior waiting space, there is a library corner with information on treatment plans and preventative health, books and magazines, a children's play area, and multiple seating options.

"Best thing about the site are the views from every window" ~ LuLu, Clinic Director

The color palette and artwork is carried throughout the center. The general treatment rooms—all with views either to rose-bushes, parks, or the natural landscape beyond—have ample space for the patient and provider. However there could be more additional space for families. The pediatric treatment room has furniture suitable for children—one chair for a family member, and a toy area.

The carpeted mental health room, which also can serve as a consult room or private waiting area has a private entrance, dim lighting, view to the landscape outside, and multiple seating options. All treatment rooms are painted with a yellow hue, have wood finishes on the cabinetry, and contain artwork from local artists. The operable windows within the treatment rooms provide temperature control for patients and staff. The trauma room, fit with an exterior heli-pad entrance gate, allows the medical helicopter direct access to patients ready for transport. Incorporating a heli-pad adjacent to the trauma room allows critical patients to get to the nearest hospital within 15 minutes, where it had been a one-hour commute by vehicle.

"Patient care has drastically improved from practicing in the old building; patients now are able to be in an ER within 15 minutes compared to one-hour, with our relationship with the fire department and heli-pad".

~Patty Bradford, Nurse Practitioner

The dedicated staff spaces, physician office, lab, medical records room, and storage, are noticeably "off-stage" with doors that allow for privacy. The dedicated staff spaces,— kitchen/break space and shared nurse station—are open and visible to patients and visitors. The lighting within the "off-stage" spaces is controlled with either florescent lighting from above or direct daylight from the windows within the space. The lighting within the kitchen/break space streams in through the separate outside entrance and the multiple windows around the corner space. The central shared workstation is well-lit from the flexible light tubes that channel bright light from the roof and produce a different spectrum of light throughout the building.

To minimize the travel distances between supplies, staff, and patients, supplies are placed along the corridor where the treatment rooms are arranged. Efficiency would have been gained if staff had a laundry facility on site for linens and garments (robes) rather than trucking dirty linens and garments to Point Reyes everyday for cleaning. The Health Center is moving to electronic medical records in a few years, and the facility has been designed with the necessary technology to make the transition achievable. Currently, every physician and staff member has a computer at a station along with a docking station for visiting staff and students; the computer accessibility allows for team collaboration to occur both virtually and on site.

Connection to Community

Moving from a downtown location to an "out of town" location in a rural community proved to be a positive change for a number of reasons, such as the open space and community parks on site, proximity to fire station emergency services, and parking. However, accessibility for some patients, such as the homeless population and farm workers, is proving to be difficult. Bolinas has a motor coach that travels through town twice daily and the Health Center is in the process of negotiating a stop at the Center.

To reinforce the visibility of the new Health Center, public awareness efforts, such as community fundraisers and opening events were held. This community outreach, along with a visible and identifiable entrance, and being the largest building in town with a well-lit site, aids in way finding for the patients and the community.

Although the Community Health Center is not yet running electronic medical records, the Center has integrated systems that link to other providers through technology. Home visits conducted by clinic staff and providers increase the Health Center's connection to the community, as does providing a shared transit ride to dental service in Point Reyes for patients in Bolinas. Extra amenities for patients and visitors given at the Health Center include balloons, stickers, juices, soft drinks, condoms, and educational materials.